Exploring the usage of learning resources by medical students in the basic science stage and their effect on academic performance.

BACKGROUND: The United States Medical Licensing Examination (USMLE) step 1 is one of the two examinations written after completion of the first two years (basic science stage) of medical school to be eligible to apply for residency training in the USA. A huge number and types of study materials are available to prepare for the exam which might confuse students choosing a resource. We investigated learning resources being used by the third and fifth-semester medical students and their association with academic performance. We also compared learning resources and exam scores of high-performing and low-performing students. METHODS: Data collection was done using structured (quantitative study) and semi-structured (qualitative study) questionnaires during a face-to-face interview. This article is about the quantitative part which was designed as a correlational study. Single factor one-way analysis of variance (ANOVA), Pearson correlation coefficient test, T-test, and Fisher's exact test were used to analyze the data. RESULTS: About half of all students used three or more commercial resources dealing with the same content. A weak negative correlation was observed between the number of commercial resources and the exam scores, especially when the number of these resources was three or more (r = -0.26). The mean exam score of textbook users was statistically significantly higher than the mean score of textbook non-users (p = 0.01). The usage of textbooks was statistically significantly higher in the cohort of top performers in comparison to the rest of the students (p = 0.006). In addition to less usage of textbooks, the mean number of review books was higher in the group of weakest students (2.84 versus 3.7; p = 0.75). CONCLUSIONS: Most students did not use professional textbooks and about half used too many commercial review resources. While the former fact was significantly associated with poor academic performance, the later fact had weak negative correlation with exam score. Pedagogical interventions are urgently needed to make the right type of learning resources available by making professional textbooks more USMLE-oriented and helping the students choose the best and right number of resources for optimum academic performance. By fulfilling the observed needs of the students in this way, they might feel empowered because of self-determination which will motivate studies.

A Legacy of Scientific Racism: William Osler's "An Alabama Student".

William Osler's essay "An Alabama Student" made John Young Bassett (1804-1851) a widely admired avatar of idealism in medicine. However, Bassett fiercely attacked the idea that all humans are members of the same species (known as monogenesis) and asserted that Black inferiority was a justification for slavery. Antebellum physician-anthropologists bequeathed a legacy of scientific racism that in subtler forms still runs deep in American society, including in the field of medicine.

Preserving Abstinence and Preventing Rape: How Sex Education Textbooks Contribute to Rape Culture.

Recent academic and popular conversations regarding #MeToo, sexual violence and harassment, and rape culture have begun to focus on K-12 educational spaces in the U.S., but they rarely examine how educational curricula actually foster or combat these dynamics. In this article, we present a qualitative content analysis of health education textbooks, which explores the following question: What implicit and explicit messages do youth receive about sexual violence, and specifically, sexual violence prevention in health education textbooks? As we explored this question, we analyzed the roles that sex education curricula may play in shaping (e.g., contributing to, intervening upon) rape culture. We found the following messages across textbooks: abstinence is the only way to preserve one's safety; lack of abstinence increases risks, including the risk of being raped; and girls/women must assume personal responsibility and enact strategies that preserve one's abstinence and prevent them from being raped. This article concludes by teasing out how curricula can shape interactions, relationships, and culture, and by offering recommendations for improving sex education curricula.

Are textbook lungs really normal? A cadaveric study on the anatomical and clinical importance of variations in the major lung fissures, and the incomplete right horizontal fissure.

INTRODUCTION: The lungs have three main fissures: the right oblique fissure (ROF), right horizontal fissure (RHF), and left oblique fissure (LOF). These can be complete, incomplete or absent; quantifying the degree of completeness of these fissures is novel. Standard textbooks often refer to the fissures as complete, but awareness of variation is essential in thoracic surgery. MATERIALS AND METHODS: Fissures in 81 pairs of cadaveric lungs were classified. Oblique fissures were measured from lung hila posteriorly to the lung hila anteriorly; and the RHF measured from the ROF to the anteromedial lung edge. The degree of completeness of fissures was expressed as a percentage of the total projected length were they to be complete. The frequency and location of accessory fissures was noted. RESULTS: LOF were complete in 66/81 (81.5%), incomplete in 13/81 (16.0%) and absent in 2/81 (2.47%); ROF were complete in 52/81 (64.2%), incomplete in 29/81 (35.8%) and never absent; RHF were more variable, complete in 18/81 (22.2%), incomplete in 54/81 (66.7%) and absent in 9/81 (11.1%). LOF and ROF were on average 97.1% and 91.6% complete, respectively, being deficient posteriorly at the lung hila. The RHF on average 69.4% complete, being deficient anteromedially. There were accessory fissures in 10 left and 19 right lungs. CONCLUSIONS: This study provides a projection of the anatomy thoracic surgeons may encounter at operation, in particular the variable RHF. This knowledge is essential for optimal outcomes in both benign and oncological procedures influenced by the fissures.

A comparative study of medical ebook and print book prices.

BACKGROUND: Although most medical libraries buy ebooks, there has been little discussion of the comparative costs of medical ebooks and print books. OBJECTIVES: To determine whether individually purchased medical ebooks cost more or less, on average, than the same titles in print format and, if so, to calculate the price differential. METHODS: The author searched the platform of monograph vendor YBP for the 1095 titles in the 'Clinical Medicine' category of Doody's Core Titles 2018 edition. For each title, the print price and the lowest ebook price were noted; the ratio of ebook price to print book price for each title was then calculated. RESULTS: On average, ebooks cost 2.20 times more than their print equivalents, though the size of the price differential varied greatly with the publisher. For some publishers, ebooks cost nearly the same amount as print books, while for others, ebooks cost three or even four times as much as the print. DISCUSSION: The greater price of some ebooks may make them unaffordable for libraries or mean that those titles cannot be purchased as ebooks even when that format would be preferred. CONCLUSIONS: Buying ebooks, at least on a title-by-title basis, can be very costly for medical libraries.

Textbook Outcome: Nationwide Analysis of a Novel Quality Measure in Pancreatic Surgery.

BACKGROUND: Textbook outcome (TO) is a multidimensional measure for quality assurance, reflecting the "ideal" surgical outcome. METHODS: Post-hoc analysis of patients who underwent pancreatoduodenectomy (PD) or distal pancreatectomy (DP) for all indications between 2014 and 2017, queried from the nationwide prospective Dutch Pancreatic Cancer Audit. An international survey was conducted among 24 experts from 10 countries to reach consensus on the requirements for TO in pancreatic surgery. Univariable and multivariable logistic regression was performed to identify TO predictors. Between-hospital variation in TO rates was compared using observed-versus-expected rates. RESULTS: Based on the survey (92% response rate), TO was defined by the absence of postoperative pancreatic fistula, bile leak, postpancreatectomy hemorrhage (all ISGPS grade B/C), severe complications (Clavien-Dindo ≥III), readmission, and in-hospital mortality. Overall, 3341 patients were included (2633 (79%) PD and 708 (21%) DP) of whom 60.3% achieved TO; 58.3% for PD and 67.4% for DP. On multivariable analysis, ASA class 3 predicted a worse TO rate after PD (ASA 3 OR 0.59 [0.44-0.80]), whereas a dilated pancreatic duct (>3 mm) and pancreatic ductal adenocarcinoma (PDAC) were associated with a better TO rate (OR 2.22 [2.05-3.57] and OR 1.36 [1.14-1.63], respectively). For DP, female sex and the absence of neoadjuvant therapy predicted better TO rates (OR 1.38 [1.01-1.90] and OR 2.53 [1.20-5.31], respectively). When comparing institutions, the observed-versus-expected rate for achieving TO varied from 0.71 to 1.46 per hospital after casemix-adjustment. CONCLUSIONS: TO is a novel quality measure in pancreatic surgery. TO varies considerably between pancreatic centers, demonstrating the potential benefit of quality assurance programs.

Walking and talking the tree of life: Why and how to teach about biodiversity.

Taxonomic details of diversity are an essential scaffolding for biology education, yet outdated methods for teaching the tree of life (TOL), as implied by textbook content and usage, are still commonly employed. Here, we show that the traditional approach only vaguely represents evolutionary relationships, fails to denote major events in the history of life, and relies heavily on memorizing near-meaningless taxonomic ranks. Conversely, a clade-based strategy-focused on common ancestry, monophyletic groups, and derived functional traits-is explicitly based on Darwin's "descent with modification," provides students with a rational system for organizing the details of biodiversity, and readily lends itself to active learning techniques. We advocate for a phylogenetic classification that mirrors the TOL, a pedagogical format of increasingly complex but always hierarchical presentations, and the adoption of active learning technologies and tactics.

CuboCube: Student creation of a cancer genetics e-textbook using open-access software for social learning.

Student creation of educational materials has the capacity both to enhance learning and to decrease costs. Three successive honors-style classes of undergraduate students in a cancer genetics class worked with a new software system, CuboCube, to create an e-textbook. CuboCube is an open-source learning materials creation system designed to facilitate e-textbook development, with an ultimate goal of improving the social learning experience for students. Equipped with crowdsourcing capabilities, CuboCube provides intuitive tools for nontechnical and technical authors alike to create content together in a structured manner. The process of e-textbook development revealed both strengths and challenges of the approach, which can inform future efforts. Both the CuboCube platform and the Cancer Genetics E-textbook are freely available to the community.

Reconsidering the Meaning of Concepts in Biology: Why Distinctions Are So Important.

Concepts have a central and important place in science, therefore, it is important that their meanings are always made clear. However, such clarity does not always exist, even in the case of such fundamental biological concepts as "gene" and "adaptation." A quick look at textbooks reveals that different meanings may be attributed to the same concept, even within the same textbook, without explicitly discussing the differences of those meanings. This can be misleading, and mask important conceptual differences. Therefore, the differences between the various meanings of the same concept should be discussed and explained in order for conceptual understanding to be achieved.

National Socialist Medical Literature and the Censorship Practices in the Soviet Occupation Zone and Early East German State.

This study examines how medical discourse and culture were affected by the denazification policies of the Soviet occupation authorities in East Germany. Examining medical textbooks in particular, it reveals how the production and dissemination of medical knowledge was subject to a complex process of negotiation among authors, publishers, and censorship officials. Drawing on primary-source material produced by censorship authorities that has not been rigorously examined to date, it reveals how knowledge production processes were structured by broader ideological and political imperatives. It thus sheds new light on a unique chapter in the history of censorship.

Representation of Fitzpatrick skin type in dermatology textbooks compared with national percentiles.

As time progresses, more patients with skin of color will be seen by dermatologists. To meet the needs of the ever-changing population, medical education needs to analyze how residents are trained in recognizing dermatological disorders in patients with skin of color. The aim of this study was to analyze dermatology textbooks to evaluate how well skin of color patients are represented compared to the current national distributions. The most common skin types depicted in the textbooks were Fitzpatrick skin types II and III, whereas the least common skin types depicted were skin types V and VI. There was a significant difference between a national distribution of skin types when compared to photographs in each of the textbooks (P<0.001). These findings emphasize the need to better represent patients with skin of color in medical textbooks.

Skin and Disease in Early Modern Medicine: Jan Jessen's De cute, et cutaneis affectibus (1601).

This article examines skin and disease in early modern medicine through the writings of the little-known Bohemian physician Jan Jessen (1566-1621). In 1601, Jessen published De cute, et cutaneis affectibus, a set of twenty-one theses dedicated to the question of whether skin disease existed. In considering Jessen and his relationship to a broader world of writing, this article makes three arguments. First, it suggests that, contrary to existing historiography, the question of skin disease was a common sixteenth-century concern. Second, it posits a professional channel for this concern, which arose from surgery and disease, rather than from anatomy and physiology. Finally, rather than positioning Jessen at the forefront of discovery, I suggest his text functions as a representative case study. It allows us to see material change in medicine within a stable Galenic framework.

Do nursing textbooks accurately describe pulse oximetry? An audit of current literature.

BACKGROUND: The assessment of a patient's vital signs is a critical nursing task. Despite this, research has found that many nurses have a poor understanding of pulse oximetry. AIM: As undergraduate students rely heavily on textbooks as an educational resource, an audit was conducted of nursing texts to determine the quality of pulse oximetry descriptions. METHOD: The audit was guided by questions based on the findings of research examining nurses' understanding of pulse oximetry. Two researchers used these questions to appraise textbook content. FINDINGS: A convenience sample of 32 contemporary nursing textbooks was appraised. Text descriptions of pulse oximetry varied from brief to more extensive, with the content ranging from superficial to detailed. CONCLUSION: Superficial, inconsistent or misleading information within basic nursing textbooks may be one factor associated with nurses' knowledge deficits about pulse oximetry. Academics and nurse educators should appraise core content of textbooks carefully before recommending textbooks to nursing students.

Elisabeth Kübler-Ross and the "Five Stages" Model in a Sampling of Recent American Textbooks.

This article examines some aspects of the enduring influence of the work of Dr. Elisabeth Kübler-Ross and especially of her "five stages" model through a sampling of recent textbooks published in the United States in selected academic disciplines and professional fields. The following are the questions to be asked:1. Does the "five stages" model appear without significant change in the textbooks described here?2. Is the "five stages" model applied in these textbooks to issues involving loss, grief, and bereavement, as well as to those involving terminal illness and dying?3. Is the "five stages" model criticized in some or all of these textbooks?4. If so, is the criticism sufficient to argue that, while the "five stages" model might be presented as an important historical framework, it should no longer be regarded as a sound theory to guide contemporary education and practice?

Post-Modern Epidemiology: When Methods Meet Matter.

In the last third of the 20th century, etiological epidemiology within academia in high-income countries shifted its primary concern from attempting to tackle the apparent epidemic of noncommunicable diseases to an increasing focus on developing statistical and causal inference methodologies. This move was mutually constitutive with the failure of applied epidemiology to make major progress, with many of the advances in understanding the causes of noncommunicable diseases coming from outside the discipline, while ironically revealing the infectious origins of several major conditions. Conversely, there were many examples of epidemiologic studies promoting ineffective interventions and little evident attempt to account for such failure. Major advances in concrete understanding of disease etiology have been driven by a willingness to learn about and incorporate into epidemiology developments in biology and cognate data science disciplines. If fundamental epidemiologic principles regarding the rooting of disease risk within populations are retained, recent methodological developments combined with increased biological understanding and data sciences capability should herald a fruitful post-Modern Epidemiology world.